Back to Basics: Orbital Cellulitis

Mon, 06/10/2019 - 5:00am

Author:

Lynn Manganiello, DO

Editor:

Alexis Pelletier-Bui, MD

Orbital Cellulitis

Infection of the soft tissue surrounding the orbit posterior to orbital septum
Results from extension of infection from sinuses, or due to respiratory infection, insect bite or trauma
Often polymicrobial - S. aureus, S. pneumoniae, anaerobes. Consider H. influenza in unimmunized, Mucormycosis in diabetics and unimmunized.

Signs and Symptoms:

Preceding URI symptoms
Fever
Pain with extraocular movements, limited extraocular movements, limited pupillary response
Chemosis, proptosis

Management:

Broad spectrum antibiotics - 2nd/3rd gen cephalosporin or unasyn
CT orbits
Optho evaluation
Lateral canthotomy if increased intraocular pressure or optic neuropathy

Complications:

Cavernous sinus thrombosis - consider if cranial nerve palsy
Frontal bone osteomyelitis
Meningitis
Epidural or brain abscess

References:

Walker, RA, Adhikari, S. "Eye Emergencies." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, Ch 241.